Bone Rarefaction Research Articles

Bone Changes in Necrosis in Diabetes Mellitus

In managing patients with diabetes mellitus with soft-tissue necrosis of the feet, we have found the bone changes on x-ray to be a determining factor in preventing amputation in a number of these patients. Bone changes in the diabetic are most often the result of neuropathy and rarely caused by ischemia with osteomyelitis. It is not generally known that rarefaction, lysis, or destruction of bone will not occur in the foot of a patient with diabetes mellitus unless the circulation is adequate. These bone changes are not uncommonly attributed to ischemia with osteomyelitis because one or both pulses may be absent in the foot, despite other evidence of good blood flow. This is a dangerous situation for the diabetic patient with this clinical picture. The misinterpretation of bone changes in the feet of diabetic patients can easily lead to unnecessary amputation. The prognosis in a diabetic patient with a soft-tissue

Urticaria pigmentosa with generalized tissue mastocytosis and blood basophilia.

In recent years there have been several reports on urticaria pigmentosa as just one phenomenon of a systemic mast-cell disease. Mast-cell accumulations have been demonstrated in several internal organs and tissues, giving rise to enlargements of the organs and to infiltration, rarefaction, and sclerosis of bones and other connective tissues.1-4However, reports on symptoms arising from increased formation of mastcell products (hyaluronic acid, heparin, histamine, serotonin) have been relatively rare. The stimulated connective tissue regeneration and fibrosis, which has been noted in many cases, is depending on a release of ground-substance mucopolysaccharides of thehyaluronic acidtype by the mast cells.5Disturbances of the blood coagulation mechanism have been reported in a few cases.6They may or may not have been related to the content ofheparin-like substancesin mast-cell granules.7Histamine, known to be synthesized in mast cells,8,9may well play a role for

CONGENITAL ANOMALIES ASSOCIATED WITH GONADAL APLASIA

The congenital anomalies associated with the syndrome of gonadal aplasia were reviewed in 55 cases. All patients in this group were short in stature. Almost half of the group had webbed neck, 13 of whom were of the Bonnevie-Ullrich type. Seven of the latter, however, changed into the Turner's type of neck in early childhood. Edema of the extremities, aortic coarctation and cutis laxa seemed to be associated with the group of neck webbing. Other somatic anomalies, on the other hand, especially shield-like chest, cubitus valgus and abnormal facies and nails, occurred with almost equal incidence among the two groups: those with and those without webbed neck. All patients with webbed neck tested for chromosomal sex showed a male pattern, whereas, of 11 patients with normal necks whose chromatin pattern was studied, 4 had female patterns. A high incidence of bone rarefaction ("osteoporosis") of unexplained nature, moderate hypertension of unknown etiology and multiple intestinal telangiectases was noticed. Several other anomalies, mostly of mesodermal origin, were found to be of a higher incidence in this group than the general population. The embryogenesis and the pathogenesis of this syndrome are discussed. Diagnosis and treatment are briefly mentioned.

Muscle action, bone rarefaction and bone formation; an experimental study.

1. In five series of experiments in eighty-two rabbits we succeeded in causing rarefaction of the calcaneum of all the animals soon after it was relieved from muscular compressing forces; new bone was generated when the calcaneum was subjected again to the stresses and strains of muscle contraction. 2. We found evidence that during muscle action pressure forces are transmitted through the bone, and that the presence or absence of these pressure forces conditions the balance between bone formation and bone removal. 3. In the calcaneum of the rabbit lack of muscular action seems to be the most important factor inducing osteoporosis. It is possible that the origin of post-traumatic osteoporosis has the same basis. 4. In our experiments bone rarefaction was characterised by a great increase in the vascularity of the bone; this increase ceased when the bone reached its final precarious bone density. Thus, vascular over-activity accompanied the removal of bone; but bone reconstruction was also seen to be accompanied by a more localised increase in vascularity. 5. From our experiments we cannot suggest that the inhibition of muscle contraction accompanying Sudeck's syndrome is responsible for this disorder, because we were unable in our animals to cause any of the other signs characteristic of Sudeck's bone atrophy. But the constancy with which we caused bone atrophy by the removal of muscle action may possibly help to explain the mechanism of bone absorption accompanying Sudeck's disease.

Calcium content of rarefied bone

o.1.The right hips of guinea pigs were traumatized in order to produce rarefaction of bone. 2.Sections of affected bone and controls were analyzed for their calcium content. 3.The results indicated minimal change as to percentage of calcium and that demineralization of bone does not exist as a physiologic entity; hence it is concluded that osteoporosis or deossification is the correct term to describe rarefied bone. o.1.The right hips of guinea pigs were traumatized in order to produce rarefaction of bone. 2.Sections of affected bone and controls were analyzed for their calcium content. 3.The results indicated minimal change as to percentage of calcium and that demineralization of bone does not exist as a physiologic entity; hence it is concluded that osteoporosis or deossification is the correct term to describe rarefied bone.

Bone Rarefaction After Skull Injuries

We have observed, several times in the past, areas of bone resorption in the skull following an injury, though in no instance was a connection between the trauma and the post-traumatic change unequivocably established. Recently, there have come to our attention, however, similar changes years after injury but with definite proof of the occurrence and nature of the antecedent trauma. The object of this paper is to present three cases and to point out that one or more years after a skull injury—not necessarily a fracture—bone absorption and bone deposition may occur in the injured area, more particularly in younger persons. While we can present only a few cases, we believe that larger institutions will be able to throw the support of their rich material into the discussion of the problem here presented. Sir Thomas Lewis once said that it took him eleven years to find his first case of coarctation of the aorta, but only one year to find the next eleven cases. Skull fractures and skull injuries are in many re...

Localized Aseptic Necrosis and Rarefaction of Bone

The osseous lesion to be reported here represents an unusual clinical and roentgenographic expression of aseptic necrosis and postnecrotic rarefaction of bone. This diagnosis was not considered preoperatively, and was established only after histologic examination. The removal of the localized disease process, under roentgenographic control, was followed by immediate and thus far continued recovery from the painful disability of one year's duration. Case Report History: A 33-year-old steel-mill worker complained of painful swelling on the ulnar aspect of the proximal phalanx of the right index finger. There was no definite history of trauma, but the patient stated that his work required repeated and firm gripping of the handle of a machine with his right hand. At the onset, one year previously, there had been only sensitiveness to pressure, but four months later the patient began to experience throbbing, nocturnal pain at the base of the right index finger. Following a direct minor blow six months before examination, he began to have more severe and constant pain, with increased sensitiveness in the proximal portion of the finger, and local swelling appeared on the ulnar aspect . Physical examination revealed swelling, local heat, and exquisite tenderness over the ulnar aspect of the proximal phalanx of the right index finger. The skin in this region was not discolored. The remaining portions of the finger were uninvolved, and motion in the metacarpophalangeal and inter-phalangeal articulations was unimpaired. Examination of the remainder of the musculo-skeletal system and of the other systems of the body was negative. Roentgen examination of the bones of the right index finger showed a small circular radio-lucent area on the ulnar surface of the distal end of the shaft of the proximal phalanx. The thin overlying cortical bone was unbroken, but was elevated like a blister. The bone immediately adjacent to this rarefied bony defect was less dense than the bone of the remainder of the proximal phalanx, of the other phalanges, and of the other hand bones, all of which appeared normal. The ulnar border of the phalanx, for about one centimeter proximal to the circular rarefied defect, appeared irregular, and at one point a definite groove was demonstrable. The soft tissues overlying these bony changes were thickened (Fig. I). A roentgenogram of the left hand revealed no abnormalities. The blood picture was a normal one. The blood Wassermann and Kahn tests were negative. An intracutaneous tuberculin skin test was negative. Repeated urinalyses revealed normal findings. Operation (Nov. 27, 1940): Through an incision on the dorso-ulnar aspect of the proximal phalanx of the right index finger, the small area of involved bone was completely excised, under roentgenographic control.

Bone Rarefaction after Trauma to Large Joint Regions without Fracture

LOCAL regressive soft-tissue changes after an acute trauma without fracture to a large joint region are fairly common and familiar. For instance, it is recognized that a violent wrench, blow, or bump to the knee can lead to severe and disabling local muscle atrophy. Occasionally, the latter is even associated with the presence of one or more small areas of rarefaction in the spongiosa near the joint. Very rarely, without having induced a fracture, an acute trauma to a large joint region instigates, in addition to soft-tissue changes, an impressive degree of bone rarefaction. In these cases, the rarefaction extends far along one or all of the bones entering into the formation of the joint, and involves both the spongiosa and the cortex. That this sequence of events can occur at all does not seem to be well known. Cases presenting rarefaction of long bones after trauma (without fracture) to large joint regions are analogous in many respects to cases showing rarefactions of hand or foot bones after trauma (n...

Fragilitas Ossium in a Family Showing Both Thickening and Rarefaction of Bones, Relative Lymphocytosis and Raised Serum Phosphatase with Absence of Blue Sclerotics and Otosclerosis

Fragilitas Ossium in a Family Showing Both Thickening and Rarefaction of Bones, Relative Lymphocytosis and Raised Serum Phosphatase with Absence of Blue Sclerotics and Otosclerosis

Department of Radiodontia: The Radiographic Diagnosis of Periapical Dental Infection in the Light of Bacteriologic Findings

THE dental radiograph is widely used as a means of detecting infection in the periapical tissues and alveolar process. Certain criteria, such as rarefaction or condensation of bone, changes in the peridental membrane and lamella, and absorption of root tip are taken as diagnostic of infection. What the physician or dentist interested in correlating systemic disease and dental infection really wishes to know is how many and what kind of bacteria are present in a given area or areas. Active infection necessitates the presence of bacteria, and only by reason of the presence of bacteria are pulpless teeth of importance from the standpoint of systemic disease. The radiographic criteria of infection, if dependable, must be a means of determining the presence or absence of bacteria in a suspected area. Such considerations bring up the question of how far one can translate radiographic evidence of infection into terms of bacteria. Does the absence of radiographic evidence of infection rule out the presence of bacteria? Does the finding of certain radiographic evidence of infection always mean the presence of bacteria? The problem is entirely a bacteriologic one, yet it is surprising how slight dependable data are available concerning the bacteriologic status of the pulpless tooth. In fact there is not available in the literature a single comprehensive bacteriologic study of dental infection by modern methods. I have endeavored by cultures of pulpless teeth to obtain further facts concerning periapical dental infection. Numerous difficulties enter into bacteriologic work about the teeth which are not encountered in similar work elsewhere. The chances of contamination are always great. If broth is used as the culture medium, one never knows just how to interpret positive results. One bacterium in a tube of liquid medium gives rise after twenty-four hours of incubation to as profuse a growth as if a large number were inoculated. Dependable data in this field then must give, first of all, some idea of the number of bacteria in the material cultured. It is imperative also that proper control be available by which the chances of contamination can be estimated numerically. A final requirement in a study such as this is use of a culture medium suitable for the growth of the bacteria dealt with here. The organisms found in chronic foci of infection are often difficult to cultivate. Rosenow has emphasized especially the need of employing a medium which supplies all gradations of oxygen tension between complete anaerobiosis and full atmospheric pressure. This is a fundamental requirement both f or proper growth and for preserving during the incubation period the specific affinity of the organism for different types of tissue. To meet these several requirements I have made all cultures in deep tubes of glucose brain agar. The tubes used are 6×¾, inches and filled as close as possible to the top without allowing the medium to touch the cotton stopper.